Forum on Seclusion and Restraints

This page is your response to the following message from Mary Ellen Copeland [facebook, April 23, 2012] :

Recently I spoke at a major national mental health conference. At these conferences, I often learn more between sessions than in sessions. This one was not an exception. I learned from highly committed, fantastic people what they were doing to assist and support people as they work their way through serious mental health challenges. I heard about how they give people hope, treat them with dignity, compassion and high regard, and help them discover their strengths and the resources they have to easily and safely help themselves feel better.

However, I also heard some things that distressed me. I wanted to share these things with you to see what you know, how pervasive these issues are, and what you feel we can do about it. I heard that upon admission in many in-patient mental health facilities, everyone is strip- searched–a very traumatizing procedure for anyone. And I heard that people who are reaching out for help from mental health challenges are routinely treated badly, and are often put in restraints and seclusion. I do understand that the safety of the people who work in these facilities and the safety of the people who are receiving services is critical. But it does seem to me that we can figure out ways to assure people’s safety without violating the values and ethics that I feel should underline all of mental health services provision. Please let me know what you have heard and what you feel we can do to address these issues as quickly as possible.

NH Hospital, where I’ve led a WRAP Principles group for 5-plus years, has done a good job reducing seclusion, and almost eliminating restraint since management made an executive decision to do so years back. Few people — far fewer than five years ago — have been restrained or seen it on their units. In rare cases where people are restrained, they are watched by a staff member the entire time. This helps two ways: it keeps the “victim” (my word for good reasons) safe, and discourages use of restraint because it requires so much staff time.Treating people with dignity is a constant theme of staff training, but some old-school civil servants simply have to die or retire before they can be replaced my someone more sensitive. These dinosaurs “know how to get things done’ and are pressured to do so by their managers. They shut down when the same managers come back from conferences and try to tell them how to get things done.Before the hospital starts stabilizing patients, they retraumatize them about half a dozen times: A family member or caregiver decides to commit them; police come, and take them to the hospital in handcuffs in a police car; a stranger at the hospital searches their belongings (not a strip search) and takes away anything they want to, including the patient’s cigarettes, and put them in a locked ward, and say they can’t leave the ward without earning privileges, which can always be revoked. Any emotional event that brings on police involvement and emergency admission to a hospital is traumatic by definition. 67 to 100 percent (depending on how you count) of adults in public mental health systems have suffered previous traumas. When a trauma survivor is re-traumatizes, all the unconscious and conscious feelings connected with all previous traumas come back as if they’re happening now. So before the hospital starts making people better, the standard admission process makes them much worse. Progress making the admission process less traumatic is difficult because most of these procedures protect hospital staff and other patients, they say. According to Major Sam Cochrane of the Memphis Police, who invented crisis intervention teams in police departments, policy requires anyone who is transported anywhere for any reason in a police car to be handcuffed, because an officer’s first concern must be his own safety. That police policy won’t change. But in crisis intervention training, police are taught several ways to make handcuffing less traumatic. I teach those techniques to officers in my frequent police trainings. Ken Braiterman

From Aine Nibhern:

August 2008 I got messed around by the mental health service in Ireland. I won’t go into the details but I felt the particular hospital I was in knew nothing about mental health. It was after requesting my records to see something specific that I realised the true extent of the problem and what was going on behind my back. For example, interacting with the Psychiatric nurses was written down as being “over familiar with the staff”. It’s not like I was asking them out on the date or anything! What a crazy system. They pushed around their “trolley of potions and poisons” (extract from my diary at the time), took €20,000 from my private health insurance but I never received access to the Psychologist or a therapist. And even the notes of the Psychologist, when I did eventually see him as an outpatient, are dubious. My family made up lies about me and I am not speaking to my siblings at the moment. So Psychiatry and the way they operate help destroy family relationships through the way they operate. I think the best way forward is to educate the public about the misinformation that is been given by the Psychiatric industry, which seems to be closely linked to the billion $$$ Big Pharma industry. The general population seem to be trained to say the mantra “Take your medication”, such is the strength of the chemical imbalance theory, which has never been proven. I hope to get into the WRAP programme shortly as I have been “drifting” for nearly 4 years. I was on an anti-depressant/SSRI for panic disorder when I developed symptoms of Manic Depression. I should have never been on the drug as my father had the same diagnosis. I try to steer clear of drugs now but I still need a lot of work on a Psychological level. Including a daily schedule, as I lost my career when I was sectioned. I was in my late 30s when all this happened. I put on weight on “anti psychotics” which are in fact tranquillizers. I went to a Psychiatrist/Psychotherapist Professor Ivor Browne recently. He is now 83. It is through him that my situation started to make more sense as he is not afraid to tell the truth and doesn’t seem to be under the spell of Big Pharma. I do not want others to have to go through what I went through. I used to think I was really ill and that it was all down to Bipolar. Now, looking back, a lot of the symptoms I experienced were probably a side effect of the medication. Aine Nibhern

From Jonathan Dosick:Thanks Mary Ellen for your concern. I am also upset by some of the changes in Mass., many in the name of ‘risk management,’ that seem to be heading backwards. This is the topic of my upcoming blog post in “Mad In America.” Strip searches are alarmingly the norm in ERs, which are not to good at distinguishing ‘mental’ from ‘physical’ health issues. I find that many of the large provider unions have shrunk away from being outspoken on patients’ rights, as ’employee safety’ (tied in tightly with liability) becomes a more predominant concern. Jonathan Dosick

Advocates for Human Potential, Inc., cannot address personal mental health problems or issues. We care very much about your concerns but we must focus our efforts on education and resource development. For more information on how to get help for yourself or the people you are supporting, please use the resources on this website.